| Organization Name: | INDIAN WELLS PODIATRY GROUP |
| NPI Number: | 1154500221 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LAWRENCE MICHAEL HORN (OWNER) |
| Mailing Address: | 1111 N China Lake Blvd Suite 301 Ridgecrest |
| State: | CA US |
| Postal Code: | 935553131 |
| Phone Number: | 7604993270 |
| Fax Number: | 7604993275 |
| NPI Enumeration Date: | 10/25/2007 |
| NPI Last Update Date: | 09/17/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | E3355 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |